MEDICARE: MARK MAMARI DDS. PSC. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	7221	KY

General Provider Information

NPI Number	:	1306917406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK MAMARI DDS. PSC. INC.

Provider Business Mailing Address
First Line	:	2503 CHELSEA DR
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-1701
Country	:	US
Telephone Number	:	859-426-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 CHELSEA DR
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-1701
Country	:	US
Telephone Number	:	859-426-9666
Fax Number	:

Authorized Official
Title or Position	:	DR.
Name	:	DR. MARK MAMARI
Credential	:	DDS
Telephone Number	:	859-426-9666

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	06/13/2008

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